The Relation between Estrogen Level, Anti-Ro (SSA), Anti-La (SSB) & Secondary Sjogren's Syndrome Patients

Abstract

Secondary Sjogrens syndrome (sSs) is one of the autoimmune diseases that are covered by a big term Rheumatoid Arthritis (RA). Estrogen level was measured for both secondary Sjogrens syndrome (sSs) and control females, anti Ro (SSA) & anti La (SSB) tests were also measured for sSs patients. the aim of this study was to find out the relation between the elevation in estrogen level and one of the serious autoimmune diseases which is Ss especially in the secondary type (in the presence of the positive results of SSA &SSB) and to clarify the reason of the high incidence of this disease in female than in male. Twenty nine females patients age range (25-40) suffering from sSs and twenty control (healthy females age between 20-35) were involved in this study. This study showed that estrogen level was significantly higher (p≤0.01) in sSs patients comparing to normal control group, with higher percentage of positive results in anti-Ro (SSA) compared to anti- La (SSB). Increase of estrogen level in sSs female may be the explanation of high incidence of sSs in females. Accordingly, Anti-Ro cause antibodies are more specific to sSs patients than anti- La.

Full text

European Journal of Scientific Research
ISSN 1450-216X Vol.31 No.2 (2009), pp.184-187
© EuroJournals Publishing, Inc. 2009
http://www.eurojournals.com/ejsr.htm
The Relation between Estrogen Level, Anti-Ro (SSA), Anti-La
(SSB) & Secondary Sjogren's Syndrome Patients
Basma Mustafa
Corresponding Author International Islamic University Malaysia
College of Dentistry, Malaysia
E-mail: drb.alahmad@yahoo.com
Tel: +60139773204; Fax: +603-6196 4724
Nazih Mustafa
International Islamic University Malaysia
College of Dentistry, Malaysia
Muhannad Kashmoola
International Islamic University Malaysia
College of Dentistry, Malaysia
Raida Khalil
Philadelphia University, Department of Biotechnology and
Genetic Engineering, Jordan
Abstract
Secondary Sjogrens syndrome (sSs) is one of the autoimmune diseases that are
covered by a big term Rheumatoid Arthritis (RA). Estrogen level was measured for both
secondary Sjogren`s syndrome (sSs) and control females, anti Ro (SSA) & anti La (SSB)
tests were also measured for sSs patients. the aim of this study was to find out the relation
between the elevation in estrogen level and one of the serious autoimmune diseases which
is Ss especially in the secondary type (in the presence of the positive results of SSA &SSB)
and to clarify the reason of the high incidence of this disease in female than in male.
Twenty nine females patients age range (25-40) suffering from sSs and twenty control
(healthy females age between 20-35) were involved in this study. This study showed that
estrogen level was significantly higher (p≤0.01) in sSs patients comparing to normal
control group, with higher percentage of positive results in anti-Ro (SSA) compared to anti-
La (SSB). Increase of estrogen level in sSs female may be the explanation of high
incidence of sSs in females. Accordingly, Anti-Ro cause antibodies are more specific to sSs
patients than anti- La.
Keywords: Secondary Sjogren`s syndrome
Abbreviations: sSs: secondary Sjogren`s syndrome, Ss: Sjogren`s syndrome, PCOS:
Polycystic Ovarian Syndrome, anti-Ro (SSA), anti-La (SSB)

The Relation between Estrogen Level, Anti-Ro (SSA), Anti-La (SSB) & Secondary Sjogren's
Syndrome Patients 185
1. Introduction
Sjogren`s syndrome (Ss) is a chronic autoimmune disease of unknown etiology characterized by
lymphocyte infiltration of exocrine glands. The most common clinical presentation is the combination
of dry eyes (xerophthalmia), dry mouth (xerostomia). Ss effecting women primarily, with female to
male ratio (9:1) (Baudouin et al., 2004 ).This disease has a broad clinical range extending from
autoimmune exocrinopathy primary Ss to extraglandular (systemic) secondary Jorgen’s syndrome
disease such as rheumatoid arthritis, systemic lupus erythematosus or systemic sclerosis (Manoussakis-
MN and Moutsopoulos-HM, 1999). Secondary Sjogrens syndrome (sSs) is one of the autoimmune
diseases that are covered by a big term Rheumatoid Arthritis (RA), but sS had certainly more serious
symptoms like xerophthalmia and xerostomia.
In autoimmune diseases, such as Sjogrens syndrome, the immune system triggers an
inflammatory response when there are no foreign substances to fight off this inflammatory response
causes the body’s white blood cells to attack and destroy certain moisture producing glands
(Aragona,1999). It may occur when a person’s normally protective immune system attacks and
destroys moisture-producing glands, including salivary (salivary –producing) glands and lacrimal (tear-
producing) glands. The lungs, upper respiratory tract, bowel, and other organs are less often affected by
Sjogren`s syndrome (Pavilidis, 1982; Robert, 2007). The exact cause for the abnormal immune
response in Sjogrens syndrome is unknown. some theories suggest that a virus or bacteria may alter the
immune system, causing it to attack the glands. certain people may have a genetic or inherited factor
that makes them more likely to develop Sjogrens syndrome(Anaya and Talal,1997). The course of the
disease is a benign autoimmune process,which might terminate in a lymphoid malignancy. Thus Ss is a
cross roads disease that offers potential insight in to the mechanisms where by immunological
deregulation may predispose to malignant transformation of B cells are already involved in an
autoimmune process(Ihrler-S, 2000; Brito-Zeron, 2005). Secondary Ss is generally diagnosed when
someone with an established autoimmune disease such as rheumatoid arthritis or systemic lupus
erythematosus develops extreme dryness of the eyes and mouth (Frederick Matsen, 2001, Yamada,
2005).
Thus, the aim of this work is to find out the relation between the elevation in estrogen level and
one of the serious autoimmune diseases which is Ss especially in the secondary type (in the presence of
the positive results of SSA &SSB)and to clarify the reason of the high incidence of this disease in
female than in male.
2. Materials and Methods
Twenty nine females patients age range (25-40) suffering from sSs and twenty control (healthy females
age between 20-35) were involved in this study. Patient with gynecological disorder like
(endometriosis or PCOS) was excluded from the study. Venous blood samples (4ml.) were collected
from each patient for the determination of Estrogen level to Estradiol in serum was measured by Radio
Immuno Assay (RIA) technique as described by Burtis C 1994. Anti-Ro (SSA) and anti-La (SSB): The
Kallested ENA profile kit (Sanofi Diagnostic Pastur) allows four parallel but separate tests to be
performed.
3. Results
Estrogen levels were significantly higher (P<0.01) in sSs patients (460±95) in comparison with the
control group (200±80).the results showed that 28.6% of the results of SSB were positive for sSs
patients in our study, while 49.3% of SSA were positive.

186 Basma Mustafa, Nazih Mustafa, Muhannad Kashmoola and Raida Khalil
4. Discussion
The presence of Anti –Ro and Anti –La circulating autoantibodies has since been reported to correlate
strongly with Ss, being present in up to 90% of patients (Daniels, 1984; Razak Abdul Salam, 2001).
The presence of anti –Ro (SSA) autoantibodies is associated with certain clinical manifestations of Ss.
In addition to that, Wittingham et al., 1983, reported particularly strong association between anti- La
(SSB) antibodies and Ss. However the role of Ro and La autoantibody –producing cells in salivary
gland biopsy tissues from patients with Ss has been demonstrated by Tengner (Tengner et al.,
1998).These findings indicate that anti –Ro(SSA) and anti –La(SSB) antibodies are produced and are
present at sites of inflammation and indicate their potential involvement in the autoimmune
exocrinopathy of this disease. This agreed with our results as we mentioned above and we see clearly
the higher incidence of anti-Ro(SSA) (49.3%)in relation to Ss.
Many scientists found that over 90% of people affected by Sjogren`s syndrome are women,
mainly in the 4th and 5th decades (Pavilidis et al., 1982).The disease can affect people of any race and
all ages. The reason of the high incidence in female comparing to male was not widely discussed.
Estrogen enhances the immune response as natural immunosuppressors. Anti-Ro antibodies
recognized the Ro complex,that environmental well as estrogens seem to translocate it to
nucleocytoplasmic and membrane sites where it is not normally found,thereby leading to the
development of autoimmunity. They suggest that a link between the effects of estrogens/androgens
levels and estrogens receptor/androgens receptor co-distribution on and/or with Ro/La autoantigens
might be implicated in the high frequency of anti Ro induction in females. However, these contribution
of the androgens and estrogens to Ss remains controversial (Shoenfeld et al., 1999).
In conclusion the elevation in estrogens level may be one of the important factors affecting sSs
patients and makes it more likely to affect female than male and this may clarify the issue of the high
incidence of sSs in female. Furthermore, the Anti-Ro cause antibodies are more specific to sSs patients
than anti- La ( Hayashi et al., 2004).
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